Provider Manual

Chapter 27: Vision Services

  

EyeMed administers all routine exams to determine if corrective lenses are required. It also dispenses hardware such as frames, lenses, and contact lenses based on the member's benefit. EyeMed is responsible for the provider network including contracting, credentialing, claims processing and payment, routine vision grievances, and claims appeals. *

 

*Exception: Medicare grievances and claims appeals are managed by EmblemHealth.

  1. Medicaid
  2. Medicare
  3. HIP including members whose care is managed by Montefiore Medical Group (CMO) or HealthCare Partners (HCP) and members who selected a PCP assigned to a St. Barnabas Hospital System or AdvantageCare Physicians (ACPNY)
  4. GHI Commercial Groups with Vision Benefits 

EyeMed is the vision services provider for all EmblemHealth members with a routine vision care benefit. This includes ASO members whose vision benefit is managed by EmblemHealth. Note: Not all EmblemHealth members have a routine vision benefit. See the member's Benefit Summary on emblemhealth.com/providers or contact EyeMed Customer Service at 1-800-521-3605 to determine if a member has routine vision coverage. Participating EyeMed providers can log on to eyemed.com or call EyeMed to obtain member eligibility and benefit information.

Members must use an in-network EyeMed provider to get covered benefits for a routine exam. For help finding an in-network EyeMed provider and to ask about benefits, please share the following EyeMed Customer Service toll-free numbers with your patients:

 

1-844-790-3878

Medicare

1-877-324-2791

Medicaid

1-877-324-4063

Commercial (HMO, PPO, POS)

1-877-324-6211

Group and Individual On/Off Exchange and Essential Plan

TTY/TDD: 711

If you are a vision service provider and interestedin joining EyeMed, visit this site or call EyeMed's provider service department at 1-800-521-3605.

See the chart for routine vision exam CPT codes, materials HCPCS, and diagnosis codes that should be billed to EyeMed. Claims submitted to EmblemHealth will be denied.